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A pediatric regimen for older adolescents and young adults with acute lymphoblastic leukemia: results of CALGB 10403.

Stock, Wendy; Luger, Selina M; Advani, Anjali S; Yin, Jun; Harvey, Richard C; Mullighan, Charles G; Willman, Cheryl L; Fulton, Noreen; Laumann, Kristina M; Malnassy, Greg; Paietta, Elisabeth; Parker, Edy; Geyer, Susan; Mrózek, Krzysztof; Bloomfield, Clara D; Sanford, Ben; Marcucci, Guido; Liedtke, Michaela; Claxton, David F; Foster, Matthew C; Bogart, Jeffrey A; Grecula, John C; Appelbaum, Frederick R; Erba, Harry; Litzow, Mark R; Tallman, Martin S; Stone, Richard M; Larson, Richard A.
Blood; 133(14): 1548-1559, 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30658992
Retrospective studies have suggested that older adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL) have better survival rates when treated using a pediatric ALL regimen administered by pediatric treatment teams. To address the feasibility and efficacy of using a pediatric treatment regimen for AYA patients with newly diagnosed ALL administered by adult treatment teams, we performed a prospective study, CALGB 10403, with doses and schedule identical to those in the Children's Oncology Group study AALL0232. From 2007 to 2012, 318 patients were enrolled; 295 were eligible and evaluable for response. Median age was 24 years (range, 17-39 years). Use of the pediatric regimen was safe; overall treatment-related mortality was 3%, and there were only 2 postremission deaths. Median event-free survival (EFS) was 78.1 months (95% confidence interval [CI], 41.8 to not reached), more than double the historical control of 30 months (95% CI, 22-38 months); 3-year EFS was 59% (95% CI, 54%-65%). Median overall survival (OS) was not reached. Estimated 3-year OS was 73% (95% CI, 68%-78%). Pretreatment risk factors associated with worse treatment outcomes included obesity and presence of the Philadelphia-like gene expression signature. Use of a pediatric regimen for AYAs with ALL up to age 40 years was feasible and effective, resulting in improved survival rates compared with historical controls. CALGB 10403 can be considered a new treatment standard upon which to build for improving survival for AYAs with ALL. This trial was registered at www.clinicaltrials.gov as #NCT00558519.
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